Embolization of a Biostar device in the pulmonary artery.

An asymptomatic 50-year-old Caucasian woman was referred to our echocardiography laboratory to monitor a Biostar septal occluder device inserted six months before in order to close a patent foramen ovale. On transthoracic echocardiography no residual shunt was observed but the device was not identifiable (Figure 1A); after injection of agitated saline solution in a vein of the right arm and the Valsalva maneuver, a remarkable paradoxical right-to-left shunt appeared (Figure 1B, video clip 1). The estimated systolic artery pressure was 25 mmHg. To better understand the pathophysiology of the shunt 3D real-time transesophageal echocardiography was performed. The septal occluder was not found on the interatrial